Neuro-TBI for adults, kids
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| Who was the first documented case of a TBI? | phineas Gage
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| What two age populations are at the greatest risk of a TBI? | 15-24 and 60-65
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| What are potential reasons for sustaining a TBI? | MVA, risk taking behaviors, failure to fly, blast injuries, assults, falls (moreso in the elderly population)
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| At wha age is the brain fully matured? | 21
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| T/F Alcohol is realtaively common in adults diagnosed with a brain injury. | TRUE 30-40%
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| What is the difference between an open vs. a closed head injury? | open: fx and penetration of the skull, closed: no skull fx or peneration
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| What is the difference between primary and secondary brain injuries? | primary: the actual force of trauma to the brain, secondary: what happens to the brain following the injury including edema, inc ICP, HTN, hemorrhage, ischemia, etc.
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| What is cou/contracoup? | cou is the initial impact and contracou is when the head then moves reverse direction
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| what is the difference between a focal and a diffuse distribution? | focal: contusion and focal infarcts, defined to a space, diffuse: distributed
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| What are the layers within the cranium? | epidural, subdural, subarachnoid, intracerebral or intracerebellar
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| What are the three grades of diffuse axonal injury? | grade I: no focal accentuation of midline structures, grade 2: focal lesion in corpus callosum, grade 3: focal lesion in cc and brain stem and cc is shifted
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| What are the three components to the glasgow coma scale? | eye opening, verbal response, and motor response
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| What is the difference between anterograde and retrograde amnesia? | antero: loss of events after and retro: loss of events prior
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| What is the definition of a vegetative state? | there is no awareness of self or environment, the cortex is disrupted but the brainstem is spared
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| T/F A person in a vegetative state can have reflexes anf involuntary movement to noxious stim. | TRUE
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| What is locked-in syndrome? | Sate of wakefullness and awareness wth quadruplegia and paralysis of lower cranial nerves
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| What is minimally conscious vs vegetative state? | Minimally conscious are a little less severe but hvae fragments of awareness (these are in the news about waking up)
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| What is a requirement for a minimally conscious state? | one of the following: give a yes or no response, verbalize intelligence, demo purposeful behavior, etc.
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| What is the Rancho Cognitive Scale? | These are the levels given to a person who has had a TBI and is recoverying. A 1 is the lowest level and the person is unresponsive. A 10 is completely purposeful and appropraite modified independence.
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| What is the Rancho scale 4? | confused agitated, heightened state of activity but dec ability to process info and respond to internal confusion
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| What is the Rancho scale 6? | confused appropraite
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| What is the Rancho scale 7? | automatic appropraite minimal assistance
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| What is the Rancho scale 8? | purposeful appropriate stand by assistance
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| What is the Rancho scale 5? | confusion inappropraite non agitated max assistance
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| What is the Glasgow outcome scale? | score 1-5, 1) death, 2) vegetative, 3) severe disability, 4) moderate disability, 5) good recovery
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| What is the best way to handle TBI pts? | keep things simple and routine, avoid things that bother the pt and use what calms them down
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| T/F the token economy is a good way to provide a automatic, quick, and easy reinforcement. | TRUE
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| What is the largest killer and disabler of children? | brain injury
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| When and what gender is most likely to sustain a TBI? | after school and boys
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| T/F A TBi is an acquired brain injury due to an external physical force | TRUE
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| What are secondary injury to an inital TBI? | edema, hemorrhages, hypoxia, ischemia, excitotoxicity, seizures, infection
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| What care causes of TBI in toddlers? | MVA, balls in street, falls
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| What is the second impact syndrome? | second concussion within hours or days of the first. 50% die and the other 50% will have permanent brain damage
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| T/F In order to have the classification of a concusion, consciousness must be lost | FALSE
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| When is a mild TBI diagnosed (hint timeframe) | when there is a change in metal status at the time of injury
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| When is a moderate TBI diagnosed (hint timeframe) | a loss of consciousness for minutes to hours, confusion for days to weeks, impairments for months or are permanent
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| T/F a lot of time more pressure is put on mental and cognitive recovery than physical recovery | FALSE, the opposite
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| What does executive function involve? | ability to monitor and regualte behvaior, understand feedback and mistakes, cognitive flexibility, thinking, sequencing, relationships, and what makes me me
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| What part of the brain is responsible for emotions? | frontal lobes and limbic systems
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| How can one manage a child with a TBI behavior? | environmental controls and reinforcement
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| What are the stages of acceptance? | denial, anger, depression, barganing, acceptance
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| What are some possible motor problems related to a TBI? | spasticity, abnormal tone, ataxia, tremors (hyper and hypo), dysarthria, apraxia
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| What is opisthotonic posutring? | extreme posturing due to high tone and requires padding
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| What are some possible sensory problems related to a TBI? | visual, perceptual, hemianopsia, diplopia, anosimai, dec auditory acuity, aphasia, hyper/hypo sensitivity
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| What are possible secondary motor impariments following a TBI that can develop overtime? | contractures, deformities, heterotropic ossifications
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| What are some physical therapy interventions? | improve functional abilities / motor control, increase: awareness to environment, purposeful responses. prevent musculoskeletal impairments, work with vestibular system (swings, bouncy balls), positioning, stretching, mobilization, cast/splint.
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| T/F serial casting can be done to manage tone or fix contractures until the pt is ready for orthotics | TRUE
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| What are some medical managements for high tone? | ablation surgery, excitation implantable device, inrathecal baclofen pump, botox, phenol
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